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` PERMIT APPLICA'i ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STPEET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.iF PERMiT tt <br /> �ma- N�_� ��.�-r� 3 r�-c�d� <br /> LEGA L7TN0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> SL.�"?��.' %)7ASJ•�� <br /> TENANT NAME i CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ��/3iNS JN L M ADDRESS ZIP CONTR.LICENSE# <br /> P C�. ���33o i�.,�.� ��c. tic <br /> PHONE ��bo�Yu3 �v-hL_ �9-.���/Hvc/ 9�'17.3 �'`v�ii,.,P.Kz �L�Z <br /> PROPOSED USE OF BUILDING � Building f7 Mechanical I� Addition I HEAT SOVRCE <br /> PERMIT Combination �_� Plum6ing WORK �� Alleration D Electnc <br /> TYPE DemOliUOn LJ Sign TYPE �( New U Gas <br /> S f Y2 Sprinkler �-� Repair/Mainl U Other <br /> CONTRACT PRICE OF WORK d �L� O v � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705- <br /> P <br /> WOI:K DESCRIPTION <br /> / <' S i••1-��- T'��%'C' S/�n'�.�./�Lt'�C' S YS TL'�� /ti� .�--t'>._. SF-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF'FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLiNG UNITS . <br /> BATHTUB FORCED AIR SYSTEMS <br /> LP.VATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UMIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY VlATER HEATER <br /> CLOTHES WAS�IER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIRGPLACE <br /> FLOOR DRAIN GAS R4NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXrIAUST FAN <br /> OTHER OTHER <br /> — — � Nr.'�?��� <br /> � <br /> I HEREBY CEfiITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIOIJS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT�NG OF A PERAqIT DOES NOT PRESUME TO GNE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW 296.200 WAC. <br /> .�1�-�� s ���'��3 <br /> Signatum of OwnedContractor uthorized Agent D te <br /> DEBIT� CREDIT CARDS ARE NOT ACCEPTED `/L <br />